Reddy et al.

World Journal of World

Pharmaceutical Research
Journal of Pharmaceutical Research
SJIF Impact Factor 8.074

Volume 7, Issue 13, 1025-1035. Reasearch Article ISSN 2277– 7105

PREECLAMPSIA: RISK FACTORS, COMPLICATIONS AND

MANAGEMENT

A. Prithi1, Adireddy Deepika Reddy2*, Y. Sowmya Deepthi3 and

Reddy Ramyalata Venkatesh4

1
Assistant Professor, Department of Pharmacy Practice, CMR College of Pharmacy,
Kandlakoya, Hyderabad – 501401.
2
* Pharm. D. Intern (Gandhi Hospital, Secunderabad) CMR College of Pharmacy,
Kandlakoya, Hyderabad – 501401 Telangana State, India.
3
Pharm. D. Intern (Gandhi Hospital, Secunderabad) CMR College of Pharmacy, Kandlakoya,
Hyderabad – 501401 Telangana State, India.
4
Pharm. D. Intern (Gandhi Hospital, Secunderabad) CMR College of Pharmacy, Kandlakoya,
Hyderabad – 501401 Telangana State, India.

ABSTRACT
Article Received on
14 May 2018, Introduction: Preeclampsia is characterized by high blood pressure
Revised on 05 June 2018, (hypertension), fluid retention (edema) and excessive protein levels in
Accepted on 26 June 2018,
DOI: 10.20959/wjpr201813-12794 the urine (proteinuria).Preeclampsia is the most common serious
pregnancy complication, affecting 4-8% of all pregnancies. The World
Health Organization (WHO) estimates that Preeclampsia is directly
*Corresponding Author
responsible for 10% of direct maternal mortality in Asia. Aim: To
Adireddy Deepika Reddy
Pharm. D. Intern (Gandhi evaluate risk factors, complications and management of Preeclampsia.
Hospital, Secunderabad) Methodology: A prospective observational study on Preeclampsia- its
CMR College of risk factors, complications and management was performed for 6
Pharmacy, Kandlakoya,
months duration in In-patient department of Gynaecology and
Hyderabad – 501401
Obstetrics in a Tertiary Care Hospital. Results: 100 Preeclampsia cases
Telangana State, India.
were collected, analysed and results were obtained. Preeclampsia was
more prevalent in the age group 21-22 years (24%) followed by 25-26years (22%) and 43%
of patients were diagnosed with Severe Preeclampsia followed by 17% with Preeclampsia.
Predominant risk factor is First Pregnancy (46%), followed by with Hypothyroidism (18%).
Predominant complication is Fetal Death (28%), followed by eclampsia (24%). Nifedipine is
the most effective drug for management of Preeclampsia and Magnesium sulfate is used is in

www.wjpr.net Vol 7, Issue 13, 2018. 1025

Reddy et al. World Journal of Pharmaceutical Research

combination with Nifedipine in severe conditions. Conclusion: Preeclampsia was more

prevalent in age group between 21-24yrs and predominant risk factor was found to be first
pregnancy. The major complication is fetal death and effective treatment options are
Nifedipine and Magnesium sulfate.

KEYWORDS: Preeclampsia, eclampsia, hypertension in pregnancy.

INTRODUCTION
Preeclampsia, the most common form of high blood pressure (BP) that complicates
pregnancy usually after 20 weeks of gestation and is primarily defined by the occurrence of
new-onset hypertension, new-onset proteinuria and pedal edema.[1]

Impact of Preeclampsia
 Ten million women around the world develop Preeclampsia each year. About 76,000
pregnant women worldwide die each year from Preeclampsia and related hypertensive
disorders. The number of babies who die from these disorders is thought to be on the
order of 500,000 per annum.
 In developing countries, a woman is seven times more likely to develop preeclampsia
than a woman in a developed country. From 10-25% of these cases will result in maternal
death.[2]
 If undetected, preeclampsia can lead to eclampsia which is one of the top five causes of
maternal and infant illness and death, causing an estimated 13% of all maternal deaths
worldwide or literally a maternal death every 12 minutes.
 Approximately 5 to 8 percent of pregnancies are affected by Preeclampsia meaning that
more than 6.6 million women worldwide suffered from the disease in 2002.
 In the U.S., Preeclampsia is responsible for approximately 18% of all maternal deaths.
 Preeclampsia causes 15% of premature births in industrialized countries and it is the
number one reason doctors decide to deliver a baby prematurely.[3]

Risk factors of Preeclampsia

 Maternal specific Risk Factors
 Maternal age (years), maternal height (cms), maternal BMI
 Past history of preeclampsia in multiparous women.
 Maternal blood group

www.wjpr.net Vol 7, Issue 13, 2018. 1026

Reddy et al. World Journal of Pharmaceutical Research

 Interval between pregnancies

 Number of previous abortions
 Sex of new born
 Medical history of any autoimmune disease
 Gestational diabetes
 Medical history of diabetes mellitus
 Family history of hypertension or diabetes mellitus among first blood relations
 Family history of preeclampsia

 Pregnancy specific risk factors

 Urinary tract infections
 Fetal malformations
 Partner related exposure
 Limited sperm exposure
 Husband’s age

 Exogenous risk factors:

 Smoking
 Stress and working women status.

Complications of Preeclampsia[6,7]
 Central nervous system
 Eclampsia (seizures)
 Cerebral hemorrhage (stroke)
 Cerebral edema
 Cortical blindness
 Retinal edema
 Retinal blindness
 Renal system
 Renal cortical necrosis
 Renal tubular necrosis
 Respiratory system
 Pulmonary edema

www.wjpr.net Vol 7, Issue 13, 2018. 1027

Reddy et al. World Journal of Pharmaceutical Research

 Laryngeal edema
 Liver
 Jaundice
 HELLP syndrome (hemolysis, elevated liver enzymes, and lowered platelets)
 Hepatic rupture.
 Coagulation system
 Disseminated intravascular coagulation
 Microangiopathic haemolysis
 Placenta
 Placental infarction
 Placental abruption
 Baby
 Death
 Preterm birth
 Intrauterine growth restriction

Management of Preeclampsia
Delivery is the ultimate treatment option for preeclampsia. Vaginal delivery is preferable to
avoid added physiologic stressors of caesarean.[8]

During labor, primary goal of management is to prevent seizures and control hypertension.
 Magnesium Sulfate: Magnesium sulfate is the drug of choice for prevention and
treatment of seizures in women with severe preeclampsia. Dosage regimen commonly
opted is 6g loading dose followed by continuous infusion at rate of 2g per hour.
 Anti-Hypertensive drug therapy: Antihypertensive drug therapy is recommended for
pregnant women with systolic blood pressures of 160 to 180 mm Hg or higher and
diastolic blood pressures of 105 to 110 mm Hg or higher.
 Hydrazine and labetalol are most commonly used anti hypertensives in treatment of
preeclampsia. Nifedipine and sodium nitroprusside are potential alternatives.
 Hydralazine: Direct peripheral arteriolar vasodilator agent. Hydralazine was used as
primary drug of choice in acute hypertensive disorders in the past. Hydralazine is
associated with worse maternal and perinatal side effects than nifedipine and
labetalol.[9,10]

www.wjpr.net Vol 7, Issue 13, 2018. 1028

Reddy et al. World Journal of Pharmaceutical Research

 Labetalol: Selective alpha blocker and non-selective beta blocker agent. Labetalol slows
heart rate, reducing myocardial oxygen consumption and decreases supraventricular
rhythm. Labetalol is safe and effective drug to use in pregnancy induced hypertension as it
controls high blood pressure faster.[11]
 Nifedipine: Calcium channel blocker. Nifedipine blocks calcium entry into cells induces
vasodilation by acting on arteriolar smooth muscle. As nifedipine is oral calcium channel
blocker hence easy to administer, convenient and more predictable.[12]
 Sodium nitroprusside: Nitroprusside causes vasodilation by releasing nitric acid.
Sodium nitroprusside is used in severe hypertensive emergency, when other medications
are not effective.[9]

METHODOLOGY
A prospective observational study on Preeclampsia – its risk factors, complications and
management was conducted during 6 months in Department of Obstetrics and Gynaecology in
Tertiary Care Hospital. Study was approved by Institutional Ethical Committee, CMR
College of Pharmacy. A structured documentation form was prepared for documentation of
study cases. Patients diagnosed as Preeclampsia with or without comorbidities are included in
the study. Cases were collected on regular basis, case analysis was done to interpret the case
information and further analysed statistically to obtain result by using ANOVA. P-
Value<0.000 was considered as statistically significant and denotes as.

RESULTS
100 Preeclampsia cases were collected, documented, analysed and results are obtained as
follows:
Distribution of patients based on age: According to age wise distribution most patients were
between the age group 21-22 (24%), followed by 25-26 (22%). (Table 1 and Graph 1).

Table 1: Distribution of patients based on age.

Age Group (years) No. of patients Percentage (%)
17-18 1 1%
19-20 17 17%
21-22 24 24%
23-24 17 17%
25-26 22 22%
27-28 7 7%
29-30 6 6%
31-32 3 3%

www.wjpr.net Vol 7, Issue 13, 2018. 1029

Reddy et al. World Journal of Pharmaceutical Research

33-34 2 2%
35-36 1 1%

Graph 1: Distribution of patients based on age.

Distribution based on diagnosis

Distribution based on diagnosis of patients in which 43% of patients were diagnosed with
Severe Preeclampsia, followed by 17% with Preeclampsia. (Table 2 and Graph 2).

Table 2: Distribution based on diagnosis.

Diagnosis No. of patients Percentage (%)
Severe Preeclampsia 43 43%
Preeclampsia 17 17%
Mild Preeclampsia 15 15%
Imminent Eclampsia 11 11%
Antepartum Eclampsia 8 8%
Non-Severe Preeclampsia 6 6%
Total 100 100%

Graph 2: Distribution Based on Diagnosis.

www.wjpr.net Vol 7, Issue 13, 2018. 1030

Reddy et al. World Journal of Pharmaceutical Research

Assessment of risk factors

Predominant risk factor is First Pregnancy (46%), followed by with Hypothyroidism (18%).
(Table 3 and Graph 3).

Table 3: Assessment of Risk Factors.

Risk Factors No. of Patients Percentage (%)
First Pregnancy 31 46%
Hypothyroidism 12 18%
Previous History of preeclampsia 6 9%
Gestational hypertension 4 6%
Gestational Diabetes 3 4%
Previous History Of Gestational Hypertension 1 1%
Previous History Of Antepartum Eclampsia 1 1%
Hypothyroidism and Gestational diabetes 1 1%
Multiple Pregnancy 1 1%
Gestational Hypertension and Gestational Diabetes 1 1%
Previous History of eclampsia 1 1%
Epilepsy and Hypothyroidism 1 1%
previous history of hypertension and hypothyroidism 1 1%
Diabetes Mellitus 1 1%
Fibroid Uterus 1 1%
Gestational hypertension and thyroid disorder 1 1%
Hypertension 1 1%
Total 68 100%
Avg. Mean 1.81
P- Value 0.7609

Graph 3: Assessment of risk factors.

www.wjpr.net Vol 7, Issue 13, 2018. 1031

Reddy et al. World Journal of Pharmaceutical Research

Assessment of Complications
Predominant complication is Fetal Death (28%), followed by Eclampsia (24%). (Table 4 and
Graph 4).

Table 4: Assessment of complications.

Complications No. Of Patients Percentage (%)
Fetal Death 13 28%
Eclampsia 11 24%
Oligohydramnios 4 9%
Intra Uterine Growth Retardation 3 7%
Abruptio Placenta 2 4%
HELLP Syndrome 2 4%
Intra Uterine Growth Retardation, Oligohydramnios 2 4%
Severe Oligohydramnios 2 4%
Breech Presentation 1 2%
Chronic TORCH Syndrome 1 2%
Decreased fetal movements 1 2%
Focal placenta accreta 1 2%
Gravid Uterus 1 2%
Oligohydramnios with PROM 1 2%
Polyhydramnios and Fetal death 1 2%
Total 46 100%
Avg. Mean 1.94
P - Value 0.000***

Graph 4: Assessment of complications

www.wjpr.net Vol 7, Issue 13, 2018. 1032

Reddy et al. World Journal of Pharmaceutical Research

Management of Preeclampsia
Nifedipine is the most effective drug for management of Preeclampsia and Magnesium sulfate
is used is in combination with nifedipine in severe conditions. (Table 5).

Table 5: Management of Preeclampsia.

Drugs No. Of Patients Percentage
Nifedipine 36 36%
Nifedipine + Magnesium Sulfate 22 22%
Nifedipine + Labetalol 15 15%
Nifedipine + Magnesium Sulfate + Labetalol 7 7%
Labetalol 3 3%
Labetalol + Magnesium Sulfate 2 2%
Magnesium Sulfate 2 2%
Nifedipine + Methyldopa 2 2%
Amiloride + Furosemide + Labetalol 1 1%
Atenolol 1 1%
Atenolol + Labetalol 1 1%
Furosemide + Labetalol 1 1%
Nifedipine + Furosemide 1 1%
Nifedipine + Levitriacetam 1 1%
Nifedipine + Magnesium Sulfate+ labetalol 1 1%
Nifedipine + Methyldopa 1 1%
Nifedipine + Furosemide 1 1%
Nifedipine + Labetalol + Magnesium Sulfate 1 1%
Nifedipine+Methyldopa+Labetalol 1 1%
Total 100 100%

DISCUSSION
Preeclampsia is characterized by high blood pressure (hypertension), fluid retention (oedema)
and excessive protein levels in the urine (proteinuria). Preeclampsia is the most common
serious pregnancy complication, affecting 4-8% of all pregnancies. The World Health
Organization (WHO) estimates that preeclampsia is directly responsible for 10% of direct
maternal mortality in Asia.

100 Preeclampsia cases in gynaecology and obstetrics department were collected in 6 months
duration in In-patient department of gynaecology and obstetrics in a Tertiary Care Hospital.

The collected cases were distributed according to age, in which more number of cases were
found between the age group of 21-22yrs (24%) followed by age group between 25-26
(22%). The similar results were found in the study conducted by Cande V Ananth et al in
2013 in which they concluded that maternal age was more prone to preeclampsia.[13]

www.wjpr.net Vol 7, Issue 13, 2018. 1033

Reddy et al. World Journal of Pharmaceutical Research

Total number of cases was distributed according to Risk factors. The predominant risk factor
was first pregnancy (46%) compared to the other factors followed by hypothyroidism (18%).
The result was found to be non-significant (P-value: 0.760). The similar results were found in
the study- Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study
conducted by Sonia Hernandez-Diaz et al in 2009 in which they concluded that risk was high
in first pregnancy followed by eclampsia.[14]

Total number of cases was distributed according to the Complications. The predominant
complication was found to be fetal death (28%) compared to other complications followed by
the eclampsia (24%). The results were found to be significant (P-value: 0.005***). The
similar results were found in the study conducted by Errol R Norwitz et al in 2002 and
concluded that fetal death was the major complication.[15]

In this present study among all Nifedipine and Magnesium sulphate was found to be effective
treatment option among all available treatment options for preeclampsia. The similar results
were found in study conducted by Laura A Magee et al in 2005 and concluded that
Nifedipine and Magnesium sulfate were the most effective treatment options.[16]

CONCLUSION
Preeclampsia was more prevalent in extremes of maternal age group and predominant risk
factor was found to be first pregnancy. The major complication is fetal death and effective
treatment options are Nifedipine and Magnesium sulfate.

REFERENCES
1. Hypertension in pregnancy-ACOG, 13.
2. Health Information about Preeclampsia. [Internet] Preeclampsia Foundation Official Site.
Available at: https://www.preeclampsia.org/health-information/149-advocacy-
awareness/332-preeclampsia-and-maternal-mortality-a-global-burden
3. Preeclampsia. org. 2018 Available at:
https://www.preeclampsia.org/pdf/Preeclampsia%20Fact%20sheet%20v2.pdf
4. Uzma Shamsi, Sarah Saleem and Noureen Nishter. Epidemiology and risk factors of
preeclampsia; an overview of observational studies. Al Ameen J Med Sci., 2013; 6:
294- 97.
5. Kirsten Duckitt, Deborah Harrington. Risk factors for pre-eclampsia at antenatal booking:
systematic review of controlled studies. BMJ, 2005; 330: 565.

www.wjpr.net Vol 7, Issue 13, 2018. 1034

Reddy et al. World Journal of Pharmaceutical Research

6. Lelia Duley, Shireen Meher, Edgardo Abalos. Management of pre-eclampsia. BMJ. Feb
25 2006; 332(7539): 463–468.
7. Solwayo Ngwenya. Severe preeclampsia and eclampsia: incidence, complications, and
perinatal outcomes at a low-resource setting, Mpilo Central Hospital, Bulawayo,
Zimbabwe. Int J Womens Health., 2017; 9: 353–57.
8. Hypertension in pregnancy-ACOG, 35.
9. Kee-Hak Lim, Guy Steinberg. Preeclampsia. Emedicine.medscape.com 2018.
Preeclampsia: Essentials, Overview, Pathophysiology. Available at:
https://emedicine.medscape.com/article/1476919-overview
10. Laura A Magee, Chris Cham, Peter von Dadelszen. Hydralazine for treatment of severe
hypertension in pregnancy: meta-analysis. BMJ. Oct 25 2003; 327(7421): 955.
11. Dharwadkar MN, Kanakamma MK, Dharwadkar SN, Rajagopal K, Gopakumar C, Divya
James Fenn J and Balachandar V. Study of Methyl Dopa Versus Labetalol in
Management of Preeclampsia and Gestational Hypertension. Gynecol Obstet (Sunnyvale)
4: 242 doi:10.4172/2161-0932.1000242
12. Kwawukume EY1, Ghosh TS. Oral nifedipine therapy in the management of severe
preeclampsia. Int J Gynaecol Obstet. Jun 1995; 49(3): 265-9.
13. Cande V Ananth, Katherine M Keyes, Ronald J Wapner- Preeclampsia rates in United
States, 1980-2010: age-period-cohort analysis – BMJ 203; 347: f6564.
14. Sonia Hernandez-Diaz, Sengwee Toh, Sven Cnattingius, - Risk of preeclampsia in first
and subsequent pregnancies: prospective cohort study. – BMJ 2009; 338: b2255.
15. Errol R., Norwitz, Chaur-Dong, Repke, John T – Acute complications of preeclampsia. –
COAG, 2002; 45(22): 308-329.
16. Magee L.A., Ornstein M.P., Von Dadelszen P. - Management of preeclampsia - BMJ
1999; 318: 1332.

www.wjpr.net Vol 7, Issue 13, 2018. 1035